Estimating Prevalence of Post-war Health Disorders with Heterogeneous Catchability and Behavioural Dependence

Effective surveillance on the long-term public health impact due to war or terrorist attacks remain limited. Such health issues are commonly under-reported, specifically for a large group of individuals. For this purpose, efficient estimation of the size of the population under the risk of physical and mental health hazards is of utmost necessity. In this context, multiple system estimation is a potential strategy that has recently been applied to quantify under-reported events allowing heterogeneity among the individuals and dependence between the sources of information. To model such complex phenomena, a novel trivariate Bernoulli model is developed, and an estimation methodology using Monte Carlo based EM algorithm is proposed which successfully overcomes the identifiability issue present in the model. Simulation results show superiority of the performance of the proposed method over existing competitors and robustness under model mis-specifications. The method is applied to analyze real case studies on the Gulf War and 9/11 Terrorist Attack at World Trade Center, US. Estimates of the incident rate and survival rate are computed by adjusting the undercount estimates for an unbiased evaluation of the post-war syndromes. The results provide interesting insights that can assist in effective decision making and policy formulation for monitoring the health status of post-war survivors.